Joint Committee on Vaccination and Immunisation (JCVI) recommendations
The JCVI interim statement on changes to the routine immunisation schedule for children in the UK was published last week. This is an important update for those campaigning to defeat meningitis, as it addresses the withdrawal of Menitorix, the vaccine currently given to infants at 12 months to protect against Hib meningitis and Meningococcal Group C disease (commonly known as MenC). Stocks of Menitorix in the UK are anticipated to run out in 2025, necessitating recommendations to be made now by the JCVI, so they can be adopted and implemented by the UK’s Departments of Health, in England, Wales, Scotland and Northern Ireland.
Who are the JCVI?
The Joint Committee on Vaccination and Immunisation (JCVI) are an expert group who make recommendations to the UK government about who should receive routine vaccinations and when, with the aim of providing the best possible protection through the smallest number of vaccines, given at the most effective times.
What the JCVI recommendations mean for MenC vaccination
The JCVI has recommended that including an infant dose of MenC-containing vaccine in the routine immunisation schedule at 12 months is no longer necessary. This is because of the decline in meningococcal disease caused by A, C, W and Y strains in the UK (a decline which can be attributed to the success of routine vaccination programmes across the UK).
Instead of routinely vaccinating infants against MenC, the Committee believe that infant protection against both MenC and MenW can be sustained from the indirect protection provided by the MenACWY vaccination, which is offered to teenagers in secondary school. This indirect protection is possible as long as current levels of MenACWY vaccine coverage are maintained.
Our view on the removal of the MenC-containing vaccine for infants
The continued decline in MenC across the UK is a vaccination success story, and one which we should all celebrate: every parent who has taken their child to an appointment and ensured they received their dose has played a part in its success.
However, removing the MenC dose at 12 months means that babies will no longer be directly protected from MenC disease. Instead, they will be reliant on indirect protection from the teenage MenACWY vaccination programme. Babies will however continue to receive vaccines which offer protection against other causes of meningitis, including MenB, Hib and the pneumococcus.
For MRF, changes to the infant immunisation schedule, which could result in increased cases (no matter how small), are always a concern. Behind every case number is an individual or family whose lives have been changed, sometimes tragically forever.
Maintaining and sustaining this indirect protection works for UK children when they are in the UK (as evidence suggests herd protection has been established) but we must also account for travel, where levels of protection against meningococcal disease vary country by country. Monitoring and understanding these patterns will be vital, just as happens for other infectious diseases like COVID-19.
It is for these reasons we will continue to remain vigilant, not only listening to our supporters (many of whom have been directly affected by meningitis) and our scientific and medical advisors, but also by continuing to analyse and assess all data released by the UK Health Security Agency (UKHSA) on cases across the UK and on vaccine coverage. Alongside this, it will be critical for us to continue to monitor and assess further JCVI recommendations.
As Liz Rodgers, our Head of Research says,
“The evidence highlighted by the JCVI suggests that, due to the success of vaccination programmes in reducing invasive meningococcal A, C, W and Y disease in the UK, an infant MenC containing dose may no longer be required. With protection against MenC and MenW for babies reliant on the teenage MenACWY school-based vaccination programmes (a programme which was significantly impacted by the pandemic), achieving and maintaining high vaccine uptake rates will be more important than ever. Public health authorities maintaining strong surveillance of disease cases and vaccine uptake rates, and making such data publicly available, will remain essential. We welcome continued collaboration with UKHSA on awareness-raising initiatives, including for those who may have missed receiving their vaccine because of COVID-19 restrictions.”
A call for continued transparency and collaboration
MRF has campaigned for many years on the importance of teenagers having their MenACWY vaccination. This is now even more critical, because of this potential future reliance on its indirect protection. Indirect protection is possible because evidence shows that, as well as protecting teenagers, it also stops them from carrying the bacteria in the back of the nose and throat. This, in turn, prevents the disease-causing bacteria being transmitted to the wider population – in an effect often referred to as ‘herd immunity’ or ‘herd protection’.
In the future, these JCVI recommendations mean teenagers who have their MenACWY vaccination will not only be protecting themselves and their peers but will also be protecting vulnerable babies in their families and communities.
As a result of COVID-19 lockdown measures in the UK, meningitis vaccination coverage has reduced, with many (understandably) struggling to get to routine appointments. As we write this, MenACWY vaccine coverage has been improving in the UK but is still yet to reach pre-pandemic levels. While the models the JCVI have used to inform their recommendations account for lower vaccine coverage (down to 20%), lower uptake does impact the effectiveness of the indirect protection model being recommended.
During the 20/21 academic year, MenACWY vaccine coverage for those in Year 9 in England did vary between local authorities, with coverage ranging from 35% in Hillingdon to 98% in West Berkshire and Hertfordshire. Across England, coverage for Year 9 was reported as 77% in 20/21, compared to the 18/19 pre-pandemic level of 88%. It is vital UKHSA monitor these variations and that local health authorities intervene to address any inequality in coverage and thus protection, using public health information campaigns that reach all communities (including using knowledge gathered from the COVID-19 vaccination programme) as well as ensuring ease of access both in school and outside of it.
Catch-up campaigns will also be vital in schools, in colleges and in universities: we welcome UKHSA’s continued collaboration on awareness-raising campaigns, as is already happening for university MenACWY campaigning targeted at this year’s incoming university students, including during the critical winter months.
We call for UKHSA to continue to work with ourselves and others in the charity sector on sustained awareness-raising among teenagers, young adults and their parents, so getting your MenACWY vaccination is as much a rite of passage as attending your school prom, getting your GCSE and A level results, or passing your driving test.
We also call for continued monitoring and transparency by UKHSA on vaccination coverage data and case incidence nationally and regionally (by local authority), releasing this publicly for analysis and enquiry to inform targeted public health interventions, including awareness-raising campaigning.
What the JCVI recommendations mean for Hib vaccination and MMR scheduling
The JCVI recommendations include a fourth dose of Hib-containing vaccine being routinely offered, which we welcome. However, we do not yet know which vaccine will be recommended (such as the hexavalent ‘6 in 1’ (DTaP/IPV/Hib/HepB) or pentavalent (DTaP/IPV/Hib) vaccine). We also do not know whether the recommendation will be for this to be given at 12 or 18 months old.
At 12 months, this will maintain the current Hib immunisation schedule but, if moved to 18 months, it will be important to understand what a new immunisation visit could mean for vaccine coverage and protection against Hib meningitis.
The recommendations also include bringing forward the second dose of the measles, mumps and rubella (MMR) vaccine from 3 years and 4 months to 18 months, where it could potentially be combined with the visit to a GP for the fourth dose of Hib-containing vaccine. Before the MMR vaccine was introduced, mumps was the leading cause of viral meningitis. Today, meningitis and encephalitis caused by mumps and measles have virtually been eliminated, an enormous success. Such success means we are supportive of all initiatives designed to ensure high MMR vaccine coverage, which this is anticipated to do.
Dr Tom Nutt, CEO of Meningitis Now (UK meningitis charity and Confederation of Meningitis Organisations member) said of the recommendations,
“These highlight what we can consider to be good news in that rates of meningitis caused by MenC are currently very low. It is also good news that the uptake of the MenACWY vaccination by teenagers is sufficiently high to afford protection from MenC to infants and children.
However, the withdrawal of a vaccine that has demonstrably protected so many lives since 2006 will be a source of worry for many people and especially parents. Any change that lessens the direct protection afforded by vaccines will naturally be a cause for concern.
At Meningitis Now, we are reassured by the evidence produced by the JCVI in support of this change. It does appear that herd immunity will be sufficient to protect infants and children. We will, however, keep this recommendation under close scrutiny and review. We plan to share all our concerns with the JCVI, including the views of all the Meningitis Now family. And – of course – the recommendation underlines the importance of people taking up all vaccinations when offered to them through the NHS. This is especially the case for teenagers being offered the MenACWY vaccination at school. By having this vaccination, you not only protect yourself; you also save the lives of others.”
Making sure no one is left behind
Defeating the multiple causes of bacterial and viral meningitis is not simple – there is no single vaccine to protect us. That is why we will continue to question and challenge the evidence where needed.
We will continue to press for new scientific developments to be considered, including the potential future availability of a ABCWY vaccine for infants and toddlers, which should widen protection against meningococcal disease (as presented at our 2021 research conference).
We will continue to be vigilant to new meningococcal strains that have increased transmissibility or virulence.
We will continue to campaign so no one is left behind in our mission to defeat meningitis.
Further resources
What vaccines are there for meningitis?
Meningococcal Groups ACWY vaccine in the UK and Ireland
Meningococcal Group C vaccine
Meningitis symptoms checker